Provider Demographics
NPI:1215047071
Name:BROWN, HAMMOND FULLER (LICSW)
Entity type:Individual
Prefix:
First Name:HAMMOND
Middle Name:FULLER
Last Name:BROWN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 WATER ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3300
Mailing Address - Country:US
Mailing Address - Phone:603-528-6086
Mailing Address - Fax:
Practice Address - Street 1:67 WATER ST
Practice Address - Street 2:SUITE 205
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3300
Practice Address - Country:US
Practice Address - Phone:603-528-6086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1039374OtherCIGNA BEHAVIORAL HEALTH
NH30420183Medicaid
NH1406027Y0NH01OtherANTHEM BC/BS
NH1406027Y0NH01OtherANTHEM BC/BS